Trichotillomania is an impulse control disorder in which the person with the condition is unable to stop themselves pulling out their own hair. It is not a condition that is talked about much, but it can destroy people’s lives and self-esteem.

However, there are a number of treatment options available for people who have been diagnosed with trichotillomania. These include:

Habit reversal training

This is a kind of behaviour therapy which teaches people with the condition to identify the conditions in which urge to pull hair arises. Through relaxation and other techniques, they are taught new responses and new behaviours. These are called ‘competing responses’ and could be something as simple as squeezing a stress toy with the hand they use to pull out hair.

Cognitive therapy

This is used to deal with any kinds of distorted thinking the sufferer experiences in relation to stress and its consequential hair-pulling behaviour.

Medication

Medication can be used as part of a treatment programme for trichotillomania, particularly an anti-depressant medication known as selective serotonin reuptake inhibitors (SSRIs). This medication can help in controlling very intense urges, such as the urge to pull hair.

For most women suffering from hair loss or thinning, the first thing they want to know is whether there is an effective treatment available for hair loss.

The first point to remember with hair loss treatment is that there is no ‘wonder cure’, although there are many organisations and individuals looking to make money by selling you such medication or ointments.
The next thing to bear in mind is that the treatment for hair loss depends a great deal on the condition itself, the person and their medical history, and even psychological or environmental factors.

Alopecia treatment

As yet, there is no cure for alopecia that has proven to be 100% effective. There are some creams, lotions and injections that can encourage hair to grow, but they don’t always work. For most people (60 – 80% of cases) hair grows back on its own.

Female pattern baldness

A lot of people with female pattern baldness, a hereditary condition, use medication called minoxidil to treat their hair loss. Most people do notice improvements, and up to 25 per cent of female hair loss sufferers experience regrowth.

The only proven treatment for female-pattern baldness is minoxidil. Most users see improvements, including a halt to the balding or slowing down of it, as well as thicker hair. Up to 25% of women experience hair regrowth.

In a surprisingly large number of hair loss cases, stress or other mental health issues are found to be a main trigger for the condition. This can make hair loss conditions difficult to diagnose, as the problem is a psychological one rather than solely physical.

Stress-related hair loss

For conditions such as alopecia areata and telogen effluvium, it is often psychological or emotional trauma that causes the hair to start falling out. Excessive stress can cause more hairs than normal to enter the resting (telogen) phase, resulting in mass shedding a number of months later. Stressful conditions which can trigger this kind of hair loss include pregnancy, surgery and miscarriage.

Trichotillomania

This is a compulsive ‘hair pulling’ disorder, part of the impulse control group of conditions. It causes the sufferer to feel an irresistible urge to pull out hairs from their own scalp, eyelashes or eyebrows. Some people with trichotillomania often feel a sense of tension before pulling hair, or whilst trying to resist the behaviour, and a sense of relief or satisfaction afterwards.

A number of people with this condition also feel a sense of shame or embarrassment about their behaviour and attempt to hide it from others.

As with any potential medical problem, the first thing you should always do if you think you have a hair loss condition is to see your general practitioner (GP).

Although not a hair loss specialist, your family doctor should still be your first port of call as he/she can take the first steps to getting you an accurate diagnosis. Your GP may ask you about:

• Your diet
• Any medication you may be on
• Your hair care routine
• Any illnesses you may have had recently

If you’re female, your doctor may also ask you some questions about your menstrual cycle and whether you are pregnant or have recently had a child.

You can also expect your GP to carry out a physical examination, blood tests and possibly a biopsy.

Referral to a specialist

After your doctor has noted down all the basics to do with your general health and is unable to diagnose you, it is likely that he/she will refer you to a dermatologist or a trichologist (a hair loss specialist) for consultation and treatment. This is where you will find out what is causing your hair loss and whether it can be treated or not, as well as learning about your hair management options.

The way in which the normal hair growth cycle works means that everyone sheds some of their hair every day. This is totally normal and is nothing to be worried about, unless of course the hair loss is excessive.
To define whether you should be concerned that you have a hair loss condition, it can be useful to know more about the normal hair growth cycle.

Hair growth cycle – key facts:

• Approximately 85- 90 per cent of all your hair is growing at any one time. This hair is in the anagen (growth) phase.

• The anagen phase generally lasts between two and six years, but can be as much as eight

• Hair grows at a rate of around 0.5 inches (1.25cm) per month. This equates to 6 inches (15cm) a year. The speed at which hair grows slows as you age.

• Around 10-15 per cent of your hair follicles are in the resting (telogen) phase at any one time. This phase lasts for one to four months, at the end of which the telogen hairs fall out.

• Normal hair shedding results in the loss of around 50 – 100 hairs a day. Hair should not fall out in clumps; if it does, you should see your GP.

• When a hair falls out, it is replaced by a new hair and the cycle begins again

Hair loss is often associated men of a certain age, which is why hair loss in women can be so upsetting. Potentially even worse than female hair loss, however, is when a hair loss condition occurs in children.
There are many causes of hair loss in children, including:

• Alopecia areata –an autoimmune disorder which causes patchy hair loss
• Tinea capitis (ringworm) – a contagious fungal infection which shows up as scaly, round patches of hair loss on the scalp
• Telogen effluvium – a hair loss condition caused by sudden or severe stress interrupting the normal hair growth cycle
• Trichotillomania – a compulsive disorder in which the child feels the urge to pull out their own hair
• Nutritional deficiency – a less common occurrence, a lack of B vitamins (i.e. biotin) or zinc in the diet can cause hair loss
• Endocrine problems – conditions such as hypothyroidism, where the thyroid is underactive, can cause hair loss

Baby hair loss

Hair loss in very young children and babies can have non-medical causes, which often go away on their own. These causes include rubbing (friction with car seat or crib mattress) and newborn hair loss, where the hair falls out to be replaced by permanent hair.